Download DOC - Great Beginnings Pediatric Dentistry

Treatment Options, Risks and Outcomes
_____FLUORIDE VARNISHES: The dental decay will be slowed down by good oral hygiene,
minimizing sugar or sweets in the diet, and the application of a fluoride varnish periodically. The
procedure is an interim treatment, which gives everyone more time to decide how to treat the
dental decay; however, it will not halt the spread of decay.
_____PROTECTIVE STABILIZATION: The child may be held by the staff, parents and/or a safetyrestraining device in an effort to restrict movement of the arms and legs, which could result in
the child injuring themselves. In our office we ONLY use this for emergency treatment that must
be done immediately, and for very short periods of time. In these cases the parent may wish to
try this rather than sedating the child. It is not always successful and the doctor or parent may
feel it is not in the best interest of the child to provide care in this manner.
_____NITROUS OXIDE (LAUGHING GAS): It is only effective if the child breaths through their
nose! If they become upset and start crying, it will not be effective. Nitrous oxide is a very mild
form of sedation, your child will not be asleep, but it will help him/her relax and better cope with
the appointment. It helps many children with gag reflexes and children who are anxious, but
cooperative. There are almost no risks to the child. Mothers who are pregnant are not allowed in
the treatment area because of the implied risks to developing fetuses. Children who have eaten
2-4 hours prior to the procedure may throw up, so following the doctor’s instructions before the
appointment are important. The gas disappears within several minutes after the child stops
breathing it, so when they are done there are no side effects.
_____ORAL SEDATION: Children with no compromising heart and lung problems are good
candidates for sedation if they are trying hard to cooperative, but are just too anxious to sit still
for the more lengthy procedures. Sedation medications unfortunately only have a calming effect
in about 70% of children. It is almost impossible to predict which children will respond favorably
to sedation medications. Some children become combative and resist all treatment, rather than
become relaxed. Those children who are sedated must be constantly monitored to insure that
their breathing and heart are responding favorably to the medications. This requires intensive
doctor time and we are limited in how many treatment slots we can dedicate to this. Sometimes
it is not effective and the parents must decide whether to proceed or discontinue the procedure.
The doctor may feel that the child is so disruptive in their reaction (even with sedation
medication) that he or she cannot safely continue. Risks, to include stopping of breathing, heart
Maria Laura Ybarra, DDS - Board Certified Pediatric Dentist - 127 Winslow Street, Watertown NY 13601
Phone: 315-681-6818 - Fax: 315-405 - www.greatbeginningsdentistry.com
stoppage, permanent brain injury or death can result as a reaction to medications or medical
problems. We can refer you out for this treatment if you decide to do so.
_____OPERATING ROOM UNDER GENERAL ANESTHESIA: Children who are very young and
unable to cooperate for extensive treatment, cooperative children that require extensive dental
treatment, patients with certain medical conditions, and patients who suffer from extreme
dental fear and anxiety may be eligible for this type of treatment. In cases where the dental
needs of the child cannot be addressed in 1 or 2 sedation visits or the patient is so disruptive
that care cannot be safely rendered are candidates for care in the hospital environment. General
anesthesia is employed to put the child to sleep and all the dental care needs are done in one
visit. The child remembers nothing of the dental procedure and we can preserve the positive
developing attitude toward good oral health and address serious dental health care needs in a
timely and reasonably safe manner. There are risks with general anesthesia which need to be
considered by the parent and will be discussed in detail at a later appointment. The risk of
providing no treatment out of fear over general anesthesia, generally outweighs the risks of the
procedure. It is done on a regular basis by Dr. Ybarra.
_____NO TREATMENT: Caries is a progressive disease. Decay can lead to abscesses, which can
spread throughout the body and in the worst case, can cause death through meningitis, sepsis or
bacterial routes. Less severe outcomes include loss of teeth and need for subsequent
orthodontic treatment. Nutritional status of children with extensive dental decay has been
shown to be compromised and these children are not as healthy as they could otherwise be.
_____RISKS: All options have risks. To do nothing when severe dental caries have been identified
can lead to problems no child should be forced to risk. Oral sedation and the operating room are
two options with greater risks than simple local anesthesia and treatment in the dental office,
but they are not unreasonable treatment alternatives and should be considered by the parents
where the dental needs warrant such a recommendation.
Maria Laura Ybarra, DDS - Board Certified Pediatric Dentist - 127 Winslow Street, Watertown NY 13601
Phone: 315-681-6818 - Fax: 315-405 - www.greatbeginningsdentistry.com